Medical Ethics PHIL 148 @ Binghamton University, Sum 11

30Jun/1126

Increasing Restrictions Leading to Alternative Methods.

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http://www.healthnews.com/en/articles/0iu$vrSDP9afpLnSBou5ZP/How-many-women-induce-their-own-abortions/

http://www.healthnews.com/en/articles/1w4dCHAxH1swVrdhfU0mZJ/Oklahoma-4th-state-to-ban-abortions-after-20-weeks/

 

 

I have put two short articles here because I will be connecting the two. The first speaks about the rate at which women are inducing their own abortions by a cheaper, less invasive, and more convenient method. The second article talks about Oklahoma becoming the 4th state to ban abortion after the 20th week of pregnancy. Mainly I would like to address the first article. It says that the rate at which women induce their own abortion is two out of every 100 and that would suggest that it is a rare phenomenon. It goes on to say that this is the report given by women who have actually been seeing a doctor for their induced abortion and so the statistics do not take into account the number of women who induce their own abortion without seeing a doctor about it.

A woman contemplating abortion must take a few things into consideration before going through with the procedure. She must think about costs (on average $430 in the first trimester, $1260 in the second trimester),  she must consider the uncomfortable doctor appointments and if she doesn’t have her own transportation then her spouse or a friend must take her which would mean she cannot keep the abortion a secret.  Therefore, an alternative that would eliminate the uncomfortable and expensive side effects of abortion, while allowing the woman to keep the sometimes embarrassing procedure private, would seem like a viable option for a woman in this sort of predicament.

The article shows that these rates are relatively low but the article also admits that the research is not sufficient enough to determine the exact rate of self-induced abortions. Many women who choose to take misoprostol usually don’t see a doctor about it and so they are not even measured into the statistics while those women who filled out the questionnaire skipped over those questions asking about their experimentation with the drug. Therefore, the actual rate is most probably higher than purported.

The second article talks about Oklohoma becoming the fourth state to ban abortion after the 20th week and also mentions that 23 other states are trying to get similar insurance restrictions for elective abortions. Many health insurance companies don’t even cover abortions today. This would show us that there are increasing restrictions being placed on a woman’s right to abort making it more and more difficult. Do you think that these increasing restrictions will cause women to search for alternative means of abortion?

Do you think these restrictions are being placed in order to make women more afraid to choose abortion?

Are these restrictions justified or immoral?

Using your own opinion or that of one of the authors we have read about this week, do you think it is moral for a woman to use an alternative means of abortion considering the complications it can bring about?

 

30Jun/1130

News Article- High school health center aiding in abortion?

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http://www.komonews.com/news/local/88971742.html

 

This is a pretty interesting news article. a woman from Seattle, WA, referred to as Jill in the article, is furious that 15-year-old daugher, with the help of Ballard high school's health center, had an abortion during school hours. Jill did not know or give consent to her daughter's abortion, as an individual can obtain an abortion at any age in the state of Washington. During school hours, Jill's daughter was sent in a gab to have an abortion, which was free of charge provided that Jill's daughter kept it strictly confidential.

This is a relatively short article, but brings about many issues that are worth discussing. One of those issues is one of autonomy; does the daughter, at only 15, have enough of a right to make a decision such as abortion without the consent of her parents? Legally, she does in the state of Washington, but does she morally? Is this a matter she should have discussed with her mother simply out of good virtue, or does the mother have no say as it is the daughter's body, therefore the daughter's choice? Furthermore, does it seem as if the daughter is rewarded for keeping her abortion secret? She was rid of any financial responsibility on the grounds that she keeps the abortion confidential.

In considering the daughter's  right to her own body, Thomson's example with the violinist immediately came to mind. Although that example is way more extreme than the one in this article, both share the question of the extent of one's rights over their own body. In this case, the mother feels that she should have known about the abortion, that her rights in the situation were taken away, and that she should have been given the power of consent over the decision. After all, her daughter is still a child at only 15 years old However, Washington's legal standing on abortion makes the daughter a consenting adult in making a decision. Should there have been more respect for the mother in the decision-making process, or was the health center right in allowing the daughter to make her own decision and leave her mother on the outside of knowing?

It's also very interesting that Jill's daughter is a pro-life advocate who decided to have an abortion. I always felt that someone doesn't truly know how he/she feel about a situation until he/she is actually in that situation. Perhaps the daughter felt that she was pro-life, but changed her mind upon becoming pregnant at such a young age. What do you think? Do you think someone can be a pro-life advocate and still support abortion?

23Jun/117

News Article 6/23 Sam Ahmed

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http://qn.som.yale.edu/content/can-international-perspective-help-create-value-based-health-system
The healthcare solution has become a very hot topic for debate in the United States.  The main issue seems to be largely focused on the amount of insurance coverage and the access to care.  Many people believe that Universal coverage may be the most logical and effective solution to this debate.  Many European nations as well as Canada have instituted these types of systems and it makes sense that the United States would try to learn from them.  For example, the most recent health care reform is similar to the Netherlands where “a recent insurance mandate has resulted in over 98% coverage…”  Swedish healthcare is also universal and for the most part publically funded.  Though these systems seem to work for these countries, they still face the similar problems the United States healthcare system does.  Ultimately, no one country has figured out the perfect solution.
Though finding an easy solution to the health care debate seems impossible, some countries have recently proposed ideas that may lead to an eventual solution.  Germany, for example, is instituting systems that “readjust risks”.  It will incorporate “up to 80 chronic conditions” for full plan reimbursement.  This reimbursement will be based on estimated costs for the care of a given condition.  This would shift the focus from providing health care to all patients to providing health care to patients who need it the most.  For insurance rates, Germany takes a stance that would anger a more Libertarian point of view in that rates are income based.  Those with higher income must pay more for health coverage.
The Netherlands have instituted a system that bundles the prices of potential health care into one lump sum rather than providing partial coverage on some parts of the procedure.  The Diagnosis Treatment Combination or DBC for short includes all treatment activities including any post treatment consultations or x-rays.  The Dutch system also allows for clients to negotiate rates with insurers which allows for potentially flexible rates.  Providing one single payment also eliminates the potential for unnecessary additional services.   This system will provide somewhat of a free market for health care as those with the most economically friendly DBCs will attract the most patients.
In Sweden, there health care system is based on the quality of the treatment.  They have institutions which track the results of each treatment up to 3 months after the procedure has been performed.  The idea here is that by publically posting results of treatments at given hospitals, then patients will be able to select where they want to seek health care based on an unbiased opinion from private registries.  Health care providers are not forced to present information to these registries but never the less almost all providers participate.
These are just three of possibly many reforms being taken around the world for the health care system.  It would be effective for the United States to take these efforts into consideration as they continue to reassess health care.  I believe that a true solution will need to take the positives of the myriad of health care systems around the world.

Which reform do you find to be the most effective?
Do you see any of these reforms working with the United
States?

What ethical perspectives are present in the institution of
these reforms?

16Jun/1128

News Article: Euthanasia

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French Woman Who Sought Euthanasia Dies

What would you do if you were faced with a medical crisis that was both terminal and painful but did not have the legal consent to perform voluntary active euthanasia? Would you just accept your fate or would you do something to change it? How would you react if you knew that the country that you loved so dearly denied you of this luxury and watched as you suffered with this unbearable illness until your dying day? What would you do then? Would you be subjected to suicide (in physically taking your own life) or would you endure in an excruciatingly painful death (that can otherwise be viewed as passive euthanasia)?

No one really knows what happened that day. Chantal Sebre was found dead in the chambers of her own home in the French town of Plombieres-les-Dijon in eastern France one Wednesday afternoon. According to the news, she was only 52 years old and was suffering from a very rare form of cancer called esthesioneuroblastoma. As rare as they come, the effects of this illness was said to have contributed to her lost of eye sight, nose and tastes senses during the last eight years of what appeared to have been her miserable life. What make matters even worse is that the excruciating pain that Sebre felt in her eye (for the tumor had caused her nose to swell several sizes beyond its original size and her eye to be pushed out of its socket) could not be contained by morphine because of its dominant side effects. This led Sebre to the only possible choice she felt had; the only choice that could stop her physical and mental torture for good: active euthanasia. The French courts, however, denied this request and that is what, I believe, led to her death (local authorities are still unsure of how she died).

What attracted me to this news article was the “before and after picture” that accompanied it. The facial tumor had completely disoriented this woman’s face and I was curious about the story that followed. One could only imagine the amount of pain she endured by just looking at the photo. Despite the fact that her autonomy was completely disregarded this case also makes me question the moral and medical ethics behind the practice of French doctors. It’s understandable that in this country the practice of euthanasia is not encouraged or enforced but something could have certainly been done to relieve this patient of her pain. I mean isn’t that what medial subjects are suppose to do? Aren’t they suppose to find other alternatives to the current problem? The news article doesn’t really go into detail but it appears as if she received a court order stating that she couldn’t be grants rights in taking her own life and was just left to die (without the help any physician). This clearly dissatisfies the viewpoints of self-determination in Brook’s argument about the use and need for euthanasia. His concept clearly justifies autonomy but I wonder if it would be safe to say so in this case because of the fact euthanasia isn’t practiced at all in France?

Reading this article also brought another interesting concept to mind. Because the news article doesn’t state the exact cause of death I assume that one is granted permission to make assumptions about how Seibre died. If she were to have proceeded into taking her own life by say an overdose of pills, would it be wrong to describe the act as voluntary active euthanasia? After all, according to Gay and Williams’ definition of euthanasia one must have intentionally engaged in an act that is intended to lead to death. Therefore, will it be flawed to say that suicide and active euthanasia was essentially the same thing? If they are both medically induced by the uptake of drugs then what is the distinction?

16Jun/1124

News Article : Euthanasia

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http://news.google.com/newspapers?id=gVUlAAAAIBAJ&sjid=ieUFAAAAIBAJ&pg=5828,2129559&dq=euthanasia&hl=en

This news article is from the Ottawa Citizen, a Canadian newspaper, from 1962 and is still relevant to this weeks ethical issues surrounding euthanasia. Suzanne Vandeput a 24-year-old woman was found guilty for murdering her 8-day-old baby. The baby was born with birth defects due to thalidomide poisoning. Thalidomide was a sedative drug used in the 1950’s until it was recalled in 1961, because it was found to cause birth defects. Suzanne’s baby was born without arms and deformed feet. Not only was Suzanne found guilty but also her husband, sister, mother and doctor were charged with complicity in the case. According to the article, the doctor gave barbiturates to the grandmother, and the mother administered them to the newborn.

I believe this news article shows the downside of euthanasia. When autonomy for the person losing their life is not accessible. This child had no choice or chance for survival in the world, with family members and doctors deciding what is the right decision for them. The prosecutor used the argument that other than her deformations the baby “was fit to live”.  However from the mother and doctor’s perspective the newborn’s malformations would have caused her grave suffering for her entire life and so the decision was made for her.  Hwang’s statement in “Rational suicide and the Disabled Individual” state that the disabled are able to make rational decisions when deciding to die, if this child were given the option to live for instead a few years rather than 8 days, the child would be able to decide if the emotional and physical pain was worth enduring in exchange for continuing her life.

I chose this article because it not only shows the downside to euthanasia it also shows how the responsibility falls on those who assisted in the euthanasia. The doctor took part in active euthanasia, as well as, non-voluntary euthanasia. This was done in Belgium, which now interestingly enough has legalized euthanasia, but at this time it was illegal, hence why all the parties involved were charged. The article is also about how the jury, even though they found the defendants guilty, asks for leniency in charging them.  So, at the time even though it was illegal, the jury could see some justification for the defendants’ actions. Normally, I would understand a jury showing leniency for someone defending passive euthanasia, but for what the mother called “mercy killing” seems a little to compassionate for murder.  Non-voluntary euthanasia gives rise to problems surrounding euthanasia because it removes the patients self-determination, autonomy, and life without consent. In some cases, not saying this one, non-voluntary euthanasia is seen as morally ethical.

The prosecutor states, “ They never seriously examined the chances of the child in this world which struggles to alleviate suffering. You cannot acquit them”. I found this interesting because it shows that the prosecutor recognizes the child will have to go through hardships to stop the pain whether it is physical or emotional. So it seems the prosecutor values life over pain and suffering.

Some questions to consider…Would you support euthanasia of a newborn knowing that the rest of the child’s life would be full of pain? Should the Doctor be charged more harshly than the rest of the family members? Should the family members be blamed more harshly for not getting a second opinion? Should we support technology that enables pregnant woman to see if their child would be born with birth defects during the period that is still legal to have an abortion?

 

16Jun/1121

News Article: Euthanasia

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Immigrant's Health Crisis Leaves Her Family on Sideline

Rachel Nyirahabiyambere, age 58, has been in a persistent vegetative state ever since she had a stroke in April of 2010. In February, her feeding tube was removed based on the decision made by her court-appointed guardian, Andrea Sloan.

What makes Rachel's case unique is the fact that because she is a recent immigrant to the United States and she has been here for less than five years, she is ineligible to receive Medicaid and thus, is uninsured. Prior to her stroke she was employed at a nursing home and received medical benefits, however, she had to leave this job (and lose the health insurance) when she moved to provide childcare for her grandchildren.  After her stroke last April, Rachel remained in a vegetative state at Georgetown University Hospital for about seven weeks; at which point the hospital began attempting to discharge her and instructed her family to locate a nursing home for her or to hire in-home care.  When her family was unable to provide the funds for this because she was uninsured, they found themselves in a precarious situation with the hospital.  In November of 2010, the hospital took action to give Rachel a court-appointed guardian; although her sons fought to retain control over their mother's care, Ms. Sloan was appointed as guardian and soon transferred Rachel to a nursing home after getting the hospital to cover the costs (an option that was not given when Rachel's family had initially came into conflict with the hospital).   Ms. Sloan then placed Rachel in hospice care and decided to have her feeding tube removed February 17th and as of March 3rd when this article was published, Rachel was still alive.

An update to the story

Rachel's feeding tube was reinstated after an advocacy group petitioned a Virginia judge on behalf of Rachel's family deciding that the tube be reinstated until all of the legal issues were sorted out.

Wow, I'm sorry if my summary was a bit on the long side, but I had to read the article a few times to get the facts straight since it jumped around a bit, so I thought it might be helpful to lay it all out chronologically 🙂  I chose this article because I found the case to be pretty unique, compared with many of the examples and cases given in this week's readings.  I think most of us have come to agree that in cases where a patient is unable to make decisions, that decision making power should automatically be given to the family. Yet, in this case, it seems like because of Rachel's family's inability to pay for her care-- they were legally denied this decision making power.  And as a consequence, Rachel's feeding tube was removed against their wishes.

Is this fair? Is this even ethical?

I think that from a utilitarian perspective, Ms. Sloan's decision would likely be supported.  Given the fact that Rachel is unlikely to make any sort of recovery, the utilitarian would say that Rachel is using resources that could be better directed to other patients with better chances. Additionally, given Rachel's state, her family is likely to already have undergone some degree of a grieving process similar to the process one goes through when someone passes away.  Letting go of Rachel and removing her from the feeding tube may actually help her family in coping with their loss. This would all be likely permissible under rule-utilitarianism especially since Ms. Sloan was appointed guardian by the court.  I feel that the deontological perspective might offer a very different analysis of this situation.  Given that it is extremely unclear as to what Rachel would have wanted, Ms. Sloan may be perceived as seriously encroaching on Rachel's dignity by making this decision without any clear evidence of her wishes. I believe that Ms. Sloan is also violating a respect for the views of Rachel's family in the matter and thus, her actions would likely be deemed unethical from deontological standpoint.

  • Are there any other philosophical perspectives that would offer a clear ethical solution to this case?
  • Do you have any disagreements with my analysis or additional aspects to add that I haven't considered? Feel free to share 🙂

This article really reminded me of the points brought up this week's reading, Hwang: Rational Suicide and the Disabled Individual-- Hwang made a point of discussing how social influence can have a huge bearing on the way ethical "right-to-death" issues are handled.  Although nonvoluntary euthanasia wasn't expressly mentioned, a few of the cases mentioned dealt with disabled people (wishing to engage in both PAS/AAS) whose quality of life was decreased many times due to the lack of funding that they received. For me it raised questions about whether or not it was justifiable for society to drive people into such an unfortunate state, and then consent to their "right to die." The connection may not seem that clear, but had Rachel been able to receive Medicaid, her family would have been free to keep her on life support as long as they needed/wanted without any legal struggle. Yet, in this respect because of Rachel's citizen status she and her family were failed by the system. Leading her family to be pressured by the hospital and court to make a decision and when they were unable to, someone was assigned to do it for them.

  • Does this case have the potential to set dangerous precedents in the future?
  • Where is economic reasoning's place within ethical decision making? Should it even have one?
  • After reading the article, were you able to discern any possible conflicts of interests in the case?
  • Had you been Rachel's family, how would you have reacted to the guardian being appointed by the court and does this have any bearing on your opinion about the case?
9Jun/1129

Patient-Professional Relationship News Article

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http://www.naturalnews.com/032044_doctors_patients.html

This article talks about doctors and how they go about treating their patients; essentially, the degree of truthfulness between the doctor and the patient during the diagnostic and treatment phase.  In this article, the  Archives of Internal Medicine released a study which concluded that the treatment doctors would recommend for themselves are more often a different treatment from the one they would recommend to their patients.  Duke university physicians performed two studies.  The first study involved 500 doctors who had to treat themselves and their patients for colon cancer.  37.8% of the doctors chose one method of treatment for themselves which entailed a higher death rate but less complications upon survival.  The majority of the doctors chose a different method of treatment for their patients which entailed a lower death rate but more complications upon survival.  The second study involved 698 doctors who had to treat themselves and their patients for a new strain of avian flu.  There was only one treatment, an immunoglobulin shot, which would lessen side effects but could possibly entail new ones.  Of the 698 doctors, 62.9% said that they would not treat themselves with the shot; however, when asked about the patient's treatment, the majority of doctors determined that they would recommend administering the immunoglobulin shots.

This article reveals that doctors aren't necessarily doing what they truly feel is best for the patients.  Higgs said, "It is easier to decide what to do when the ultimate outcome is clear."  Maybe this is the reason why doctors aren't being as truthful to their patients as they should be; maybe the fear of the unknown that plagues the patient plagues the physician to a equal or higher degree as well.  Telling the patients the truth is one ethical dilemma but treating them differently from how they would treat themselves is absurd.  I was shocked by the statistics that revealed how doctors would treat themselves differently from their patients.  I was always under the assumption that the doctor would be able to place himself/herself into their patients' "shoes" and be able to decide what is best for the patient or display some sort of care ethics.  There must be reasons for why there such a disparity in treatment.  Why do you think there was such a disparity in the two studies mentioned above?  In general, do you feel that doctors make decisions based on malpractice fears?  In general, do you believe doctors sometimes are caught up in care ethics and make emotion based decisions rather than fact based?  In general, do you believe doctors are just trying to be utilitarian and see, diagnose, and treat patients as efficiently as they can?

I personally chose this story, because I felt the statistics jumped off the page.  The two studies revealed that a majority of doctors would treat themselves differently than they would treat their patients.  This act surpasses the fact that doctors sometimes don't tell the truth; they don't act truthfully which I believe is worse.  Higgs sums it up best when he says, " However honest a citizen, it was somehow part of the doctors job not to tell the truth to his patient."

 

 

9Jun/1131

Patient-Professional Relationship News Article

Posted by

http://www.cnn.com/2011/US/06/07/sissy.boy.experiment/index.html?iref=allsearch

There have been comments and questions about whether children should be afforded a certain amount of autonomy and decision making. There seems to be a general agreement that parents and physicians should make decisions for children, but what happens when the parents and doctors are making the wrong decisions? Does the relationship between the doctor and child matter at all or only the relationship between the doctor and parents because the parents are supposed to make decisions for the child? Is this third-person medicine approach in the best interest of the child?

Not long ago, and still in some circles, homosexuality was thought of as a disease or disorder. Doctors and researchers like to cure or resolve diseases and disorders and in the case of children, refer to parents for consent and sometimes assistance in this goal. For the child this is a paternalistic model in which their perceived needs are considered over what they want, or their autonomy. In this article a clear abuse of this role was done by both Dr. Rekers and the parents of Kirk Murphy. Kirk liked to play with doll and wear his hair long, expressing his autonomy; his parents and Dr. Rekers neglected the welfare of this boy by severely punishing him for these actions that came natural to him. Eventually he was so well trained in denying his homosexuality he ended up having a long successful military career. The physical and psychological harm was evident, following him his whole life until he made his last act of autonomy by taking his life.

If you consider the relationship between Kirk’s parents and Dr. Rekers the parents, after realizing the harm they did, may say it was also paternalistic, however it could easily be said it was a partnership because the parents didn’t have to beat their son, they chose to. As a child did Kirk deserve autonomy to act how he wanted? What kind of relationship did Kirk’s parents have with Dr. Rekers? What ethical implications does their relationship have in term of how Kirk was treated? These are only a few of the many ethics questions that could be asked in regards to this article. This is obviously an extreme case of endangering the welfare of the patient an complete ignorance of his individual autonomy, what other examples could you think in which the child’s autonomy should be considered over what the doctors and parent want?